医院类型对急性自发性脑出血患者结局的影响：一项基于人群的研究。
Influence of Hospital Type on Outcomes of Patients With Acute Spontaneous Intracerebral Hemorrhage: A Population-Based Study.
机构信息
From the Department of Neurology (J.M.-F., A.R.-P., L.P.-S., M.G.-J., A.M.-D., R.M., Á.L.-G., G.E.D., P.C.-R.), Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Neurology (A.N.-G., B.L.R., A.P.-M., H.Q.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat; Department of Neurology (D.R.-L.), Hospital Vall d'Hebron, Barcelona; Department of Neurology (S. Amaro, L.L.), Hospital Clínic Barcelona; Department of Neurology (Y.S., M.P.C.), Hospital Universitari Dr Josep Trueta, Girona; Department of Neurology (A.R.-C., E.G.S.), Hospital del Mar, Barcelona; Department of Neurology (I.P., D.W., N.P.D.L.O., O.F.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (M.G.-C.), Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí; Department of Neurology (D.V.-J.), Hospital Universitari Arnau de Vilanova, Lleida; Department of Neurology (N.G.), Consorci Sanitari del Maresme, Mataró; Department of Neurology (D. Cocho), Hospital General de Granollers, Granollers; Department of Neurology (D. Cánovas), Hospital Universitari Parc Taulí, Sabadell; Department of Neurology (O.P., N.R.-V.), Hospital Universitari Vall d'Hebron; Department of Neurology (L.S.), Hospital Universitari Joan XXIII, Tarragona; Hospital Universitari d'Igualada, Igualada (J.P.); Hospital de Figueres (X.C.), Figueres; Department of Neurology (J.Z.), Hospital Verge de la Cinta, Tortosa; Consorci Sanitari Alt Penedès-Garraf (E.C.), Vilafranca del Penedés; Xarxa Assistencial Universitària Manresa (N.M.C.), Manresa; Department of Neurology (J.K.), Hospital Universitari Mútua de Terrassa, Terrassa; Stroke Programme (S. Abilleira), Health Department of Catalonia, Barcelona; and Catalan Health Department (M.S.-P., O.F.), Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain.
出版信息
Neurology. 2024 Jul 23;103(2):e209539. doi: 10.1212/WNL.0000000000209539. Epub 2024 Jun 14.
BACKGROUND AND OBJECTIVES
Whether the outcome of patients with spontaneous intracerebral hemorrhage (ICH) differs depending on the type of hospital where they are admitted is uncertain. The objective of this study was to determine influence of hospital type at admission (telestroke center [TSC], primary stroke center [PSC], or comprehensive stroke center [CSC]) on outcome for patients with ICH. We hypothesized that outcomes may be better for patients admitted to a CSC.
METHODS
This is a multicenter prospective observational and population-based study of a cohort of consecutively recruited patients with ICH (March 2020-March 2022). We included all patients with spontaneous ICH in Catalonia (Spain) who had a pre-ICH modified Rankin scale (mRS) score of 0-3 and who were admitted to the hospital within 24 hours of onset. We compared patients admitted to a TSC/PSC (n = 641) or a CSC (n = 1,320) and also analyzed the subgroup of patients transferred (n = 331) or not transferred (n = 310) from a TSC/PSC to a CSC. The main outcome was the 3-month mRS score obtained by blinded investigators. Outcomes were compared using adjusted ordinal logistic regression to estimate the common odds ratio (OR) and 95% CI for a shift in mRS scores. A propensity score matching (PSM) analysis was performed for the subgroup of transferred patients.
RESULTS
Relevant data were obtained from 1961 of a total of 2,230 patients, with the mean (SD) age of 70 (14.1) years, and 713 (38%) patients were women. After adjusting for confounders (age, NIH Stroke Scale score, intraventricular hemorrhage, hematoma volume, and pre-ICH mRS score), type of hospital of initial admission (CSC vs TSC/PSC) was not associated with outcome (adjusted common OR 1.13, 95% CI 0.93-1.38). A PSM analysis indicated that transfer to a CSC was not associated with more favorable outcomes (OR 0.77, 95% CI 0.55-1.10; = 0.16).
DISCUSSION
In this population-based study, we found that, after adjusting for confounders, hospital types were not associated with functional outcomes. In addition, for patients who were transferred from a TSC/PSC to a CSC, PSM indicated that outcomes were similar to nontransferred patients. Our findings suggest that patient characteristics are more important than hospital characteristics in determining outcome after ICH.
TRIAL REGISTRATION INFORMATION
ClinicalTrials.gov Identifier: NCT03956485.
背景与目的
自发性脑出血（ICH）患者的预后是否因入院医院类型而异尚不确定。本研究旨在确定入院时的医院类型（远程卒中中心[TSC]、初级卒中中心[PSC]或综合卒中中心[CSC]）对ICH 患者结局的影响。我们假设 CSC 入院患者的结局可能更好。
方法
这是一项多中心前瞻性观察性和基于人群的研究，纳入了连续招募的 ICH 患者队列（2020 年 3 月至 2022 年 3 月）。我们纳入了所有在加泰罗尼亚（西班牙）发病 24 小时内入院且ICH 前改良Rankin 量表（mRS）评分 0-3 分的自发性 ICH 患者。我们比较了 TSC/PSC（n=641）或 CSC（n=1320）入院患者的结局，还分析了从 TSC/PSC 转至 CSC（n=331）或未转至 CSC（n=310）患者的亚组结局。主要结局为盲法研究者评估的 3 个月 mRS 评分。采用调整后的有序逻辑回归比较结局，以估计 mRS 评分变化的常见比值比（OR）和 95%置信区间（CI）。对转院患者亚组进行倾向评分匹配（PSM）分析。
结果
共纳入了 2230 例患者中的 1961 例，平均（SD）年龄为 70（14.1）岁，713 例（38%）为女性。调整混杂因素（年龄、美国国立卫生研究院卒中量表评分、脑室内出血、血肿体积和 ICH 前 mRS 评分）后，初始入院医院类型（CSC 与 TSC/PSC）与结局无关（调整后的常见 OR 1.13，95%CI 0.93-1.38）。PSM 分析表明，转至 CSC 与更好的结局无关（OR 0.77，95%CI 0.55-1.10；=0.16）。
讨论
在这项基于人群的研究中，我们发现，在校正混杂因素后，医院类型与功能结局无关。此外，对于从 TSC/PSC 转至 CSC 的患者，PSM 表明其结局与未转院患者相似。我们的研究结果表明，ICH 患者的结局更多取决于患者特征，而不是医院特征。
临床试验信息
ClinicalTrials.gov 标识符：NCT03956485。
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